Form Contents

Required fields are marked with an asterisk (*).
Do you have a confirmed placement listed in InPlace? (Placement commencing between 26 February and 23 June 2024) *

Please contact your Placement Officer to request your placement details in InPlace are reviewed. Once placement is confirmed in InPlace you can return to complete your application form.

My details
Date of Birth *
(This must be your La Trobe student email address - do not use your LTU log-in. If you incorrectly use your LTU log-in, you will not receive correspondence relating to your application from us)

Scholarship details
Ensure this code is the correct code and applies to the current Semester. Including an incorrect code may have an affect on the success of your application.
How do you think the Industry Placement Bursary will reduce your financial hardship while undertaking your placement? * Select one:
How do you plan on using the Industry Placement Bursary to assist with placement expenses? *

Personal circumstance
Are you or will you be the first person in your immediate family to attend university? (immediate family = parents, brothers, and sisters)
Are you of Aboriginal Australian or Torres Strait Islander descent?
Have you ever spent time in formal out-of-home care? (e.g. foster care, residential care, kinship care or been a ward of the state)
(months)
Do you have a medical condition or disability which impacts your ability to study? Examples of medical conditions and disabilities include but are not limited to: Physical impairment (e.g. blindness), Learning disabilities (e.g. dyslexia), Chronic pain, Eating disorder (e.g. anorexia), Mental illness (e.g. depression), Major illness (e.g. cancer)
(to receive consideration for this criteria, you will be required to provide evidence, see below) Personal statement max 2500 characters
You must provide a recent (within 12 months) statement of support from a medical professional who treated or is currently treating your condition(s)/disability. Ensure the contact details of the professional and date is included. PLEASE NOTE: .pdf file type ONLY. Max file size 8MB.
Are you or have you been a refugee?

Family circumstance
What is your household structure?
Do you have children?
Parenting

Financial circumstance
Has your education been adversely affected by your financial circumstances or do you expect your tertiary education to be adversely affected by your financial circumstances? You will be required to provide evidence
Do you, the applicant, currently receive any Centrelink benefits (e.g. Youth Allowance or health care card)?
For information on suitable evidence check our supporting documentation requirements website.
(.pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)
You will be asked to provide evidence below. Evidence includes 3 payslips or Notice of Assessment from the Australian Taxation office.
Evidence can include copies of your last 3 payslips, or a copy of Australian Tax Office Notice of Financial Assessment, these can be yours or the people you are financially dependent on. If you are dependent on others (your parents/partner), financial documentation must be in their name in order for us to establish an overview of household income.  If you are uploading more than one document, we suggest that you save the pages together in pdf as you can only upload ONCE in this section(.pdf, .doc, .docx, .rtf, .txt, .jpg or .png file types only. Max file size 8MB)


Impacts on education
Has your education been disadvantaged by difficult circumstances not outlined above? (examples of difficult circumstances may include abusive family circumstances, excessive carer duties, chronic medical condition of a child, death of close relative, homelessness, recent multiple relocations, recent separation of parents, relationship breakdown, victim of crime, bullying.)
(to receive consideration for this criteria, we require supporting evidence, see below) (max. 250 words)
(This may be in the form of a SEAS Statement, death notice, police report or statement by a relevant responsible person. For example; health care professional, social worker, counsellor, religious or community leader, school principal or teacher etc, unrelated to you as the  applicant, who can verify the circumstances. Statements of Support must  be recently dated (within 12 months), on letterhead or include contact details of referee. Statement must include duration and impact of the circumstances.  *Applicants who do not supply supporting documents will not be scored for difficult circumstances. .pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)

Acknowledgement
I accept that the Industry Placement Bursary is offered and paid on the condition that the recipient maintains enrolment in an approved clinical placement subject or Work Integrated Learning (WIL) experience at LaTrobe University: *
I accept this bursary is not transferable to another institution, under any circumstances: *
I agree it is the recipient's responsibility to contact the Australian Taxation Office (ATO) and Centrelink for advice regarding the taxation and Centrelink payment implications of the bursary: *

Privacy

All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information in your application to determine your eligibility for a scholarship, bursary or grant, and to assess your application as part of the ranking and allocation process. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose or disclosed to any person who is not part of the La Trobe assessment and allocation process, without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting the Scholarships Office. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy

Validation